Organization
KMDT SERVICES LLC
Active
Organization
KMDT SERVICES LLC
Active
Other names
Signs of Change Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
KATHARINE HELENE MCHUGH LCSW (PRESIDENT)
(571) 279-8144
Entity
Organization
Contact information
Practice address
8420 DORSEY CIR, MANASSAS, VA 20110-8300
(571) 279-8144
Mailing address
7937 FLAGER CIR, MANASSAS, VA 20109-7437
(571) 279-8144
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0904007119
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945247
—
VA
01
—
020063P10
MEDICARE NUMBER
—
Enumeration date
11/12/2015
Last updated
11/12/2015
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